Orthopedic traction table

ABSTRACT

An orthopedic table is disclosed by which a patient&#39;&#39;s spine, shoulders and hamstrings may be placed in traction in a degree that is partly related to his size and weight. The patient is harnessed to the head and foot ends of the table while lying substantially horizontal. Thereafter, the central region of the table is lowered by tilting of its upper and lower sections whereby the patient&#39;&#39;s weight is removed from the table in part and transferred to the harnesses. To aid in accomplishing a desired distribution of reaction forces within the patient, the apparatus operates to pull the patient&#39;&#39;s legs upwardly in the direction of their length. The apparatus by which the patient&#39;&#39;s head and arms are harnessed to the table is made yieldable in varying degree so that the table operator can adjust the relative amount of force applied to the patient&#39;&#39;s head and shoulders and to enable him to adjust the absolute amount of those forces.

United States Patent 11 1 Daniels Oct. 23, 1973 ORTHOPEDIC TRACTIONTABLE [21] Appl. No.: 192,413

s2 U.S. cl. 128/71 51 1111.01. A611 5/00 [58] Field of Search 128/71,72, 73, 74, 128/75, 70, 25 R; 269/322-326 [56] References Cited UNITEDSTATES PATENTS 2,262,271 11/1941 DeCamp 128/74 2,152,431 3/1939 Jensen128/74 2,950,715 8/1960 Brobeck 128/71 3,404,679 10/1968 Bevilacqua128/71 2,598,204 5/1952 A116 ....128/74x FOREIGN PATENTS OR APPLICATIONS1,121,687 4/1902 France 128/71 1,020,154 11/1957 Germany 128/71 PrimaryExar nineP-Richard A. Gaudet Assistant Examiner-J. Yasko Attorney-HarveyC. Nienow et al.

[57] ABSTRACT An orthopedic table is disclosed by which a patientsspine, shoulders and hamstrings may be placed in traction in a degreethat is partly related to his size and weight. The patient is harnessedto the head and foot ends of the table while lying substantiallyhorizontal. Thereafter, the central region of the table is lowered bytilting of its upper and lower sections whereby the patients weightisremoved from the table in part and transferred to the harnesses. Toaid in accomplishing a desired distribution of reaction forces withinthe patient, the apparatus operates to pull the patients legs upwardlyin the direction of their length. The apparatus by which the patientshead and arms are harnessed to the table is made yieldable in varyingdegree so that the table operator can adjust the relative amount offorce applied to the patients head and shoulders and to enable him toadjust the absolute amount of those forces.

10 Claims, 13 Drawing Figures Pmmtuumzsms 3.766912 SHEET 1W4 lNVENTOR E.ROBERT DANIELS BY/VW/M ATTORN EYS mimflluctza ms 3.766312 SHEET 2 BF QINVENTOR E. ROBERT DANIELS BY /W/%ZZ ATTORNEYS mmmacrza m; SHEET w Q3,766,912

R O T N E V W E. ROBERT DANIELS ATTORNEYS PAlENItunmama 3.75 6312 SHEET0F 4 INVE INTOR E. ROBERT DANIELS ATTORN EYS ORTHOPEDIC TRACTION TABLEThis invention relates to improvements in orthopedic appliances and itrelates particularly to improvements in orthopedic intermittent tractiontables.

ln the preferred embodiment, the patientlies face up upon a generallyhorizontal table which is divided lengthwise into two parts whichfforconvenience, are

7 called the upper part and the lower part, because they Pathologyinvolving the cervical spine, shoulders, I

and low back is usually followed by contractures or tightness of thesoft tissues related to the involved areas. Some loss of flexionandrotation of the neck often results along with loss of flexion andabduction of the shoulder, and loss of flexion in the low back withshortening of the hamstrings.- Relieving these contractures, to recovernormal motion, is the most effective treatment in relieving the symptomsand is often the most effective treatment in preventing progression ofthe pathology. The invention relates to an apparatus that aids inrelieving such contractures. lt aids particularly in stretching ofcontracted tissues and hamstrings and its object is to provide animproved apparatus for that purpose.. Presently available apparatusproduces straight, in-line traction with no physical means for improvingjoint motion.

It has been found that improved traction is effectively and safelyaccomplished by application of a force that is related partially to thepatients weight, by pulling his torso and feed in a direction oppositethe pull on his arms and by pulling his head to stretch his neckin thedirection in which his arms are pulled. The apparatus of the inventionpulls the patients arms and head upwardlyagainst a downward pull on thelower portion of the patients body. The arrangement permits proportionalcontrol of the amount of the force applied to the head relative to thatapplied to the remainder of the body. Pulling upwardly on the arms makesit possible to apply tension over the full length of the patients bodyfrom arms to feet without the application of undue force to the patientsneck. It is important to recognize that it is not desirable to simplystretch the patient by pulling on his hands at one end and his feet atthe other. The stretching force that is applied to the several parts ofthe body along its length is advantageously'different. Greater force issafely and advantageously applied to the legs than is applied to theback and shoulders of the patient. Nonetheless, it is .preferred thatall of these several parts of the body be pulled simultaneously forseveral reasons. First, such simultaneous pulling minimizes the numberof points at which the force application apparatus must be attached tothe patient. Additionally, it reduces treatment time. The need for anapparatus arises when the degree of force to be applied exceeds what canbe conveniently or safely applied in self-exercise. Since attendance ofa professional is obviously preferred when force is large or unusual, itis advantageous to reduce treatment time. Also, the application of forcesimultaneously over the full length of the patient tends toresult in thedissipation of that force at the points offering greatest resistance andwhich most needs the stretching regardless of where they occur over thebodys length.

The invention provides an apparatus by which this method is practicedgenerally. The method it provides is refined somewhat in that the forcesare applied at a rate and in a sequence that minimizes patientdiscomfort and apprehension. The forces are added until all are appliedsimultaneously. To accomplish these results is another object of theinvention.

underlie the back and legs of the patient respectively. The patient isordinarily positioned with his lower back and upper portions of his bodyresting on the upper part with his arms extending over .his head andcrossed there in the region of his wrists. Thearms are held in thatposition by an upper holder. His head is held to the upper holder by aharness that extends under his occiput and chin. A lower holder isfastened to the patients feet or legs. In the preferred embodiment, theupper holder is carried by the upper table part and thelower holder iscarried by the lower table part. They are spaced horizontally, ofcourse, and may be at the same 1 height. In the preferred embodiment,the twoholders are elevated in the process of stretching the patient.

The foot or lower holder is elevated a greater amount.

This is a desirable but not a critical feature.

The patient is stretched under 'his'own weight; or rather part of hisown weight, by lowering the table parts. Alternatively, the holders areraised or, as in the preferred embodiment, both table parts are tiltedso that the holders are elevated higher than the portions of the tableparts below thepatients middle section. He isheld by his arms, and inpart by his occiput and chin, at one end and by hisfeet or legs at theother end. The table parts are tilted so that the patients weight isused partially to apply the force but they are tilted at an angle andabout an axiswhich results in the application of a different stretchingforce to the back than what is applied to the legs.

The table is ordinarily not lowered so'much that all of the patientsweight is transferred to the holders. instead, the table is tilted sothat the body tends to bend at the waist-with the spine curved as itdoes when bending over and so that the legs tend to bend backward intolocked position. First the lower back and then an increasingly greaterportion of the torso is lifted in some degree from the upper part .ofthe table whereby weight is transferred gradually to the holdersprimarily through the arms and legs but also through the neck as thearms are made to stretch. In the preferred method the patients hips andlower back lose contact with the table. The body stretches downfroritthe upper holders so contact is only partially maintained and bodyweight is transferred to arms and neck. However, the feet are elevatedto a higher point and in the preferred embodiment, the lower table partmoves away from the patients buttocks and thighs so that the pull alongthe length of the leg is relatively great. The patient finally assumes aposition in which his legs form an angle approaching ninety degrees withhis back in the preferred method. Also, in the preferred method, thepatients torso is free to move down the tilted upper portion of thetable with a minimum of friction whereby the proportion of his weightthat is borne by the neck and arms is rather directly related to tiltangle of the table. The table is adjusted so that its upper part movesto an angle about thirty degrees to the horizontal and the lower part istitled to about 60. In the preferredembodiment,

practiced, controls the order and the rate of force application. It isdesirable that the transition between force application and forcerelease be gradual to avoid discomfort and apprehension and forcirculatory purposes. Also, it is preferred that force application becyclic so that rest periods alternate with tensioning periods. It ispreferred that the cycle include a short dwell period of high force ineach cycle. To provide that kind of force application is another objectof the invention. Such a cycle is provided in the preferred embodimentby converting uniform rotational motion of a motive means into a rockingmotion of the table parts that is nearly sinusoidal in the case of theupper table part and which approaches sinusoidal movement in the case ofthe lower table part. However, the movement of the foot end of the lowerpart traces a cyclic curve whose peaks are sharper, and whose troughsare shallower, than sinusoidal. These motions are produced in thepreferred embodiment by rotating the upper table part about a fixed axisclose to the plane of the table when horizontal and by rotating thelower table part about an imaginary moving axis located substantiallyabove that plane. It is possible, within the invention, to achive anequivalent result by moving both rotational axes but that results inlateral translation of the patient and a more complex structure. One ofthe objects of the invention is to provide an apparatus that willaccomplish the result without undue cost and complication. That thisresult has been achieved is apparent from an examination of thepreferred embodiment illustrated in the drawings. In those drawings:

FIG. I is an isometric view of an orthopedic table embodying theinvention and is shown in a state in which a minimum amount of traction,or no traction at all, would be applied to a patient occupying thetable;

FIG. 2 is an isometric view of the table of FIG. 1, its several partshaving been moved to a position in which maximum traction is applied toa patient occupying the table;

FIG. 3 is a view in end elevation of a fragment of the patient holdingmeans associated with the head end or upper part of the orthopedic tableof FIGS. 1 and 2;

FIG. 4 is a view in side elevation of the apparatus of FIG. 3 mounted ona fragment of the upper table part;

FIGS. 5, 6 and 7 are schematic representations of the major workingparts of the table showing the position of those parts relative to oneanother and to a patient occupying the table during different phases ofthe cycle of table operation; and

FIG. 8 is an isometric view of the table with its side panels and tableparts removed to expose the frame and drive mechanism;

FIG. 9 is an isometric view of the underside of the lower part of thetable;

FIG. 10 is an isometric view, of the underside of the upper part of thetable shown assembled with a portion of the frame of the unit and withthe patient holding means;

FIG. 1 l is an isometric view of a fragment of the main drive mechanismof the unit;

FIG. 12 is a cross-sectional view of a fragment of the sliding pivotmechanism of the lower table part shown from the end; and

FIG. 13 is a cross-sectional view taken on line 13-13 of FIG. 12.

GENERAL ARRANGEMENT The general arrangement of the preferred embodimentis illustrated in FIGS. 1 and 2. The whole table is generally designated10. Its lower portion is enclosed by a skirt 12 formed of a series ofside panels. A portion of the skirt is omitted at the head end toprovide access to some adjusting mechanism to be described later. Thatmechanism is not visible in FIG. I or FIG. 2 because it extends downbelow the top of the table. The skirt is cut away at the sides, in theregion designated 14, to provide clearance for the inner ends of theupper and lower table parts when they are tilted from a horizontalposition shown in FIG. 1 to the elevated position shown in FIG. 2. Thelower table part is generally designated 16. The upper table part isgenerally designated 18.

At the beginning and end of an operating cycle, those table parts 16 and18 are arranged horizontallyas they are shown to be in FIG. 1. Duringthe cycle of operation, they are tilted. In FIG. 2 they are shown tiltedto v near maximum position. The patient to be treated lies on the tablewith the upper part of his body on the upper part 18 of the table andwith the lower part of his body on the lower part 16 of the table. Hisarms are stretched to a position above his head and are crossed so thatthey extend around the arm holder portion 20 of the upper holder 22. Inpreferred form, the table and the arm holder are sized so that thepatients arms will cross approximately in the region of his wrists. Theupper holder also includes a head holder portion 24 to which an occiputand chin harness 46 is attached. That harness is secured to the U-shapedportion of the holder and it'extends under the patients head and chin.The length of the upper section 18 of the table is such that itunderlies his head and the whole of the patients back. His legs and feetrest on the lower portion 16. His feet are secured, usually by hisankles, to a lower holder 48 whose position and harness length areadjustable whereby patients of different heightcan be accommodated. Boththe method and the apparatus are arranged so that no adjustment otherthan position of the upper arm holder 20 and the length of the harnessstraps that secure the harness of foot holder 48 and that secure headharness 46 is required to accommodate patients of different size.

Lying on the table with his arms folded over the arm' holder, his headin the head harness and his feet secured in the feet harness, thepatient is ready for the application of tension. That tension is appliedin this embodiment by lowering the inner end of both table sec tionswhile raising the outer ends. The foot end of the table is made to moveupwardly in the direction of its length as it tilts up. This maintainstension on legs and hamstrings. It is advantageous to alternateapplication of tension forces with a rest period. Doing that permits thesafe and tolerable application of relatively great tensioning forces.The invention applies maximum tension for a short period called a dwell"period. However, the force is not actually maintained at a uniform levelover a dwell period. Instead, it changes continually but the degree ofchange in the high tensiondwell period is less than the degree of changeduring the remainder of the cycle. This is accomplished in the inventionby tilting the table parts so that the patient is bent with his legs atan angle near to the plane of his back and then by moving the table tocarry the legs upwardly without appreciably changing the angle.

In this embodimenLthat kind of motion is accomplished by pivotallymounting the lower table on an arm which is itself pivoted for rotationabout an axis spaced a substantial distance from the connection of thetable and arm. In the particular structural arrangement employed in theembodiment shown in the drawings, the axis of arm rotation isadvantangeously no less high than the axis of table rotation relative tothe arm when the table is in horizontal position. In this case, thepivot point of arm rotation is elevated to the level of the tableitself. The two corner portions 60 and 62 act merely as a coveringoverthe arm pivot structures as best shown in FIG. 2. Those corners are partof the base.

FRAME AND DRIVE The frame and the apparatus by which the table parts aremoved are best shown in FIG. 8. The frame includes four corner posts.Posts 64 and 66 are located at the lower or foot end on the near and farsides, respectively, in FIG. 8. The legs 68 and 70 are located at thenear and far sides, respectively, at the upper or head end of the unitin FIG. 8. The legs at the near side of the frame in FIG. 8 areconnected by a lower side rail 70 and'at the far side by lower side rail72. The upper side rails arenot continuous because of the need toaccommodate downward tilt of the inner end of each of the tablesections. Thus the near side of the frame has its upper rail dividedinto a foot end upper rail 74 and a head end upper rail 76. The foot endrail part on the far side is numbered 78 and the head end upper rail atthe far side is numbered 80. Among the several braces that interconnectthe upper and lower side rails, there is a vertical post at each sidethat extends downward from the upper end of the foot end upper rails.The vertical section on the near side is identified by the numeral 82.The other is only partly visible and is numbered 84. There are threecross members that connect the two sides of the frames. The one at thehead end is numbered 86 and the one at the foot end is numbered 88. Thethird one 90 interconnects the vertical posts 82 and 84. It has beenpointed out specially because it is this cross brace on which the motormount plate 92 is mounted. The drive motor is combined with a reductiongearing unit. The combination is identified by the reference numeral 94.The output of that unit rotates a crank 96 which in this case has theform of a circular disk. It is coupled to the motor drive unit at itscentral axis and it carries a pivot pin 97 (see FIG. 11) parallel withthe central, drive axis at a point on the disk removed from the centralaxis. A main drive rod 98 is coupled to that pin and motion of the driverod is made to tilt the two table sections.

Each of the tables sections is mounted upon a subframe. The upper tablesection subframe is identified by the numeral 102. It is shownassembled'with the remainder of the frame in FIG. 8 and it is shownagain in FIG. where it is assembled with the upper table.

The subframe of the. lower table part is numbered 104. It is not shownin FIG. 8 but it is shwon in FIG. 9 assembled to the lower part 16 ofthe table. It includes two brackets 106 and 108 by which it has pivotalconnection to a pair of L-shaped arms 110 and 112 which are mounted inparallel upon a pivot rod 114. The pivot rod is pivotally connected tothe upper frame rails at the foot end by a pair of pillow blocks 116 and118.

These same .L-shaped arms are interconnected at their opposite ends by adrive shaft 120. The driving arm 98 is connected to that drive shaft 120at a bearing 122. As the crank 96 rotates, its rotational motion isconverted to a substantially sinusoidal oscillatory motion of the driveshaft 98 about the axis of pivot rod 114. Shaft 120 at the end of thearms and 112 also moves sinusoidally about that same axis. The lower endof the arms are segmented to permit the drive shaft to be located in anyof several sets of pivot holes in the arms. The structure is visible inFIG. 11 where the lower end of arm 110 is shown to be segmented so itcan be opened and the drive shaft relocated.

The upper table subframe 102 is made to rock in substantially anoscillatory motion as the crank 96 rotates. The subframe 102 is pivotedat pivot axis to the upper side rails at thehead end of the frame.Brackets or cranks 132 and 133 extend downwardly from the subframe andhave pivotal connection with two long drive arms, both of which arepartly visible in FlGS. 8 and 1 1 where the oneon the near side isnumbered 134 and the one on the far side is numbered 136. At the footend of the unit, these long rods have pivotal'connection to the driveshaft 120. Thus it is thatthe motor and reduction gear unit 94 is madeto drive both table subframes, and the table parts associated withthem,in a coordinated fashion. 1

The upper table subframe 102 simply rocks in an oscillatory motionthrough an angle of about 30 in this preferred embodiment although thatangle is easily changed by connecting the long drive rods 134 and 136 toanother pair of the severa pivot points shownto be incorporated in thebrackets or cranks 132 and 133. At the opposite end of the unit, thedegree of motion imparted to the subframe 104 of the lower table unitcan be altered by connecting the arms; 110 and 112 to different ones ofthe several pivot points that areshowri to be included in the cranks 106and 108.

To change motion of the two table sections proportionally to oneanother, the drive: shaft 120 is simply moved to another pair of theseveral pivot points that are shown to have been provided in the lowerends of the two L-shaped arms 110 and 112. I

There is still another variable that can be altered to adjust the degreeand character of the movement of the lower table section. The effectivepivot for that table rotation is made to lie above the table by use ofthe combination of two pivot connections on the table itself. One ofthose connections has already been described and it is the pivotalconnection between the arms 110 and 112 and the frame brackets 106 and108 of frame section 104. The other pivotal point also moves relative tothe main frame. In FIG. 9 the two side channels of subframe 104 areshown to be formed with an elongate slot toward the inner end of thelower table part. Those slots receive the respectively associated end ofthe two retractable pivot pins that are carried in channels fixed to theupper side rails. The channels are numbered and 152 in FIG. 9.. Theseelements are in the slot of frame 104. The channel 150 has its outerwall slotted and its inner wall perforated with a series of holes formedopposite the slot. The head is pulled out to retract the shank from onehold and after the pin is moved laterally in the slot it is insertedthrough another hole. Adjustment of the pin position changes the degreein which the lower end of the table moves upward along its length and isa primary means for adjusting'leg and hamstring tension. Together thetwo structures that pivotally interconnect the lower table section andthe main frame serve as a preferred form of a means for making the lowertable rotate about an apparent axis which lies above the lower tablesection and is permitted to move upwardly and rearwardly during tableoperation to produce the tension peak and dwell" action.

The apparatus includes a means for adjusting both the absolute and therelative degree in which tension is applied to arms and head. In thisembodiment that means comprises the upper holder 22. It includes an armholder in the form of a yoke consisting of a flat portion 200 on whichthe arms are placed and a curved wall 202 behind which the arms arecrossed. A rearward extension 204 of flat portion 200is slottedlongitudinally, as best seen in FIGS. 1 and 2, to receive a clampingbolt 206 which clamps the extension to a U- shaped backet 208. Thatbracket is held by a pivot pin and clamp nut combination 210 to one endof a lever 212 which is pivoted at an intermediate point on main pivotpin 214. A curved, downward extension 216 of lever 212 carries one endof a bias spring 218 by which the lever 212 and the whole arm holder isbiased to the counter-clockwise position it occupies in FIGS. 4, 5 and10. The bias spring extends from a handle 220 carried by the extension212 to a fixed connection 222 on the underside of upper table section18. Changing the position of handle 220 changes the degree in which thespring 218 is stretched whereby the bias of the arm holder is'adjusted.A second lever 230 has a similar downward extension from its connectionto the same main pivot pm 214. This lever is also biasedcounterclockwise against a stop (not shown). The bias spring 232 extendsfrom adjustable handle 234 to the bracket 222. The other end of lever230 is U-shaped. It extends upwardly behind the arm holder and then backdown to another pivotal connection at 236 to the main pin 214. Thisassembly together with'the head harness 46 (FIG. 1) is the head holder24.

The bias with which the head holder 24 and arm holder hold the patientis adjustable by positioning the respectively associated ones of handles234 and 220.

The several rollers 250 at the lower end of the upper table section arefreely rotatable, padded and closely spaced so that they obviate thefriction that might otherwise impede movement of the patient ,downagainst the bias of the upper arm and head holders when the table istilted. They help also in permitting the patient to return to theinitial zero tension starting position at the end of each cycle of tablemovement.

FIGS. 5, 6 and 7 are schematic diagrams of the action of the workingparts of the table as they appear at different times in the cycle oftable operation. The manikin in those figures has proportionsapproximating those of an average human being. The apparatus in thosefigures includes an upper subframe 102a, an arm holder 20a, a headbracket 44a, an upper table 52a, a lower subframe section 104a slottedat 154a and a pin 150a extending through that slot and serving as apivot axis, a lower table section 16a, a foot holder 48a, an operatingarm 112a secured to the frame at a pivot 118a and secured to the lowerframe section 1040 at a bracket 106a, a drive motor crank 9611, a mainoperating rod 98a connected from the motor output crank 96a to the liftarm 112a, an upper table crank 132a, and a long operating'rod 134a whichtransfers motion from the L-shaped arm (here T-shaped) 112a to the uppertable crank 132a. The manikin has its arms raised over its head andfolded across the arm holder 20a. The head harness 46 a under and aroundthe manikins head and chin is tied by flexible cord 160 to the headholder 44a.

The manikins head, torso and hips rest on the upper table. The legs reston the lower table and the feet are secured at the ankles to the footholder 48a. The table is horizontal in that initial conditionillustrated in FIG. 5. The lower table is positioned, such that the pinrod 150a, which is attached to the frame and serves as a pivot for tablemovement, is at the extreme right end of the slot 154a. It remains inthat position as illustrated in FIG. 6 when the crank 96a has rotatedthrough an angle of The several lever arms and pivot points are arrangedso that the lower table has tilted to an angle approximately twice thatof the upper table. Separation between the holders is now somewhat lessthan it was initially. The patients body has begun to fold in a way thatapplies most of his weight to the upper table. The table being tilted,the patients weight can be divided into two force components; a verticalcomponent and a lesser horizontal component toward the right, in FIG. 6.In FIG. 6 that horizontal component has just begun to force the torsoaway from the upper holders. The effect of that separation is toincrease the traction applied to the arms, shoulders and upper spine ofthe manikin. In FIG. 7 the table is tilted in further degree so that thehorizontal component of the force applied to the table by the weight ofthe patient has increased to a greater degree applying a substantialamount of traction to the arms and shoulders and upper spine whereby thearm and head holders have rotated clockwise slightly'. In FIG. 7 thewhole lower table 16a has been lifted as evidenced by the fact that thepivot axis a now occupies an intermediate position along the slot 154a.The patients legs have been pulled upwardly so that his hips are pulledpartially away from the upper table section 52a. His back is curved andstrong tension related to his weight is applied to his hamstrings.

FIG. 7 represents the extreme traction position. The

main motor crank 96a has rotated through an angle of and furtherrotation will move the apparatus to the position illustrated in FIG. 6and then return it to the initial condition illustrated in FIG. 5. Thecycle of operation is such that initial movement experienced by thepatient is gradual whereby apprehension is minimized. Then the rate offorce application is increased at the upper body area. The forcesapplied to the shoulders and arms and neck are applied over a longerperiod in the cycle than are the forces applied to the hamstrings butthe force application is not as extreme as it is to the hamstrings. Thelatter are stretched primarily over the short dwell" period atmid-cycle.

The relative amount and duration of these forces, that is of the forcesapplied to the upper portion of the body with respect to the forcesapplied to the lower portion of the body, can be adjusted by the simpleexpedient of adjusting the tilt angle of the two sections of the table.In preferred form, they tilt so that they are approximately at 90 to oneanother as i'lustrated in FIG. 7. Ordinarily, if the tilt of one sectionof the table is decreased then the tilt of the other section isincreased. This can be accomplished readily by adjusting the location ofthe pivot points at the intersection of the crank 32 and long lever 134of FIG. 8 and at the pivotal interconnection of the long lever 134 andthe L-shaped arm 112 and by adjusting the position of pivot pins 150along the frame rails. Production models are arranged so that the tableoperator can alter those pivot points with relative ease to accommodatethe need in different patients for a different degree of tensioning.

However, the primary control of degree of tension that is applied to apatient is exercised by adjusting the bias with which movement of thearm and head holders is opposed. The tension that is actually applied tothe shoulders and arms and neck of the patient depends upon the degreein which his torso moves away from the upper holder. In general then,the amount of tension that is applied at the upper portion of thepatients body is determined by the bias of arm holder bias spring 218.To a lesser extent it is determined by the bias of head holder spring232.

The several features of the invention provide a number of' advantageswhich may not be immediately obvious. For example, it is often helpfulif the patients head is held turned to one side during treatment. Thestructure includes a means by which this may be accomplished. ln FIGS. 1and 2 the head harness 46 is connected to holder 24 by two plyant chainsor cords. The cords are connected to opposite sides of the U-shapedholder by a connection that can be moved up and down those arms to aselected position. in these Figures they are both connected at an upperlevel. If one is moved down the arm the harness will tend to rotate andhold the patients head in rotated position. Reversing position of theconnections results in opposite rotation of the patients head.

Another advantage is that the tension applied to a patient can befurther adjusted by addition of a belt secured at its ends to oppositesides of the table base and extending up over the patient. By making thebelt of resilient material the range of tensions that canbe applied isextended considerably. If the belt does not stretch then the tension canbe more concentrated over part of the cycle.

Although I have shown and described certain specific embodiments of myinvention, 1 am fully aware that many modifications thereof arepossible. My invention, therefore, is not to be restricted exceptinsofar as is necessitated by the prior art.

I claim:

1. in an orthopedic table for treating a patient by the application offorces tending to elongate portions of his body:

upper holding means for holding the patient at the upper portion of hisbody by at least one of his head and his arms;

lower holding means for holding the patient at the lower portion of hisbody by at least one of his legs and his feet, the lower holding meansbeing disposed in a position removed horizontally from the upper holdingmeans; and

adjustable supporting means intermediate said upper and lower holdingmeans for supporting, in variable degree, the torso of a patient beingheld by said upper and said lower holding means, said supporting meanscomprising a table divided in the midregion of its length into an upperpart disposed to underly the back of a patient and a lower part disposedto underly the legs of a patient, and a tilting means for tilting theupper and lower table parts oppositely about spaced pivot axis and forimparting motion to said lower holder to increase its separation fromsaid upper table part as the table parts are tilted.

2.- The invention defined in claim 1 in which the upper portion of saidtable is movable in the direction of its length away from said upperholding means when tilted.

3. The invention defined in claim 1 in which said upper holding meanscomprises an arm holder over which a patient may fold his hands and armsand comprises a head harness. i

4. The invention defined in claim 3 in which said head harness isresiliently mounted for yieldability in the direction of the lower endof the upper part of said table.

5. The invention defined in claim 3 in which said upper table comprisesa torso portion adapted to underlie a patients back and in which saidhead harness and said arm holder are movable relative to said torsoportion in the direction of its length.

6. The invention defined in claim 5 in which the head harness and armholder are capable of relative movement in the direction of the lengthof said torso portion and are resiliently biased toward a given positionrelative to said torso portion.

7. The invention defined in claim 1 in which the lower holder is fixedto the lower table part and in which that part is moved generally in thedirection of its length away from the upper table part as the tableparts are tilted.

8. An orthopedic table for treating a patient lying on the table by theapplication of forces tending to elongate portions of his body,comprising:

upper holding means for holding the patient at the upper portion of hisbody by at. least one of his head and his arms; lower holding meansdisposed at a position removed horizontally from the upper holdingmeans, for holding the patient at his lower extremities; and

adjustable supporting means intermediate said upper and lower holdingmeans for supporting, in variable degree, the torso of a patient beingheld by said upper and said lower holding means and comprising a tabledivided in the mid-region of its length into an upper part disposed tounderly the back of the patient and a lower part disposed to underly thelegs of the patient;

said adjustable supporting means further comprising means for utilizingsaid upper and lower table portion such that the central region of thetable is lowered and such that the ends of the table and said holdingmeans are elevated and such that the lower holding means is displaced insubstantially the direction of the length of said lower table sectionaway from the mid-region of the table.

9. Said invention defined in claim 8 in which said adjustable supportingmeans further includes means for increasing the separation in thehorizontal direction of the upper and-lower table sections when saidsections are tilted.

10. The invention defined in claim 8 in which said lower holder is fixedto said lower table section and in which said means for displacing saidlower table lower holder comprises means for displacing said lower tablesection in the direction of its length.

* IF l l

1. In an orthopedic table for treating a patient by the application offorces tending to elongate portions of his body: upper holding means forholding the patient at the upper portion of his body by at least one ofhis head and his arms; lower holding means for holding the patient atthe lower portion of his body by at least one of his legs and his feet,the lower holding means being disposed in a position removedhorizontally from the upper holding means; and adjustable supportingmeans intermediate said upper and lower holding means for supporting, invariable degree, the torso of a patient being held by said upper andsaid lower holding means, said supporting means comprising a tabledivided in the mid-region of its length into an upper part disposed tounderly the back of a patient and a lower part disposed to underly thelegs of a patient, and a tilting means for tilting the upper and lowertable parts oppositely about spaced pivot axis and for imparting motionto said lower holder to increase its separation from said upper tablepart as the table parts are tilted.
 2. The invention defined in claim 1in which the upper portion of said table is movable in the direction ofits length away from said upper holding means when tilted.
 3. Theinvention defined in claim 1 in which said upper holding means comprisesan arm holder over which a patient may fold his hands and arms andcomprises a head harness.
 4. The invention defined in claim 3 in whichsaid head harness is resiliently mounted for yieldability in thedirection of the lower end of the upper part of said table.
 5. Theinvention defined in claim 3 in which said upper table comprises a torsoportion adapted to underlie a patient''s back and in which said headharness and said arm holder are movable relative to said torso portionin the direction of its length.
 6. The invention defined in claim 5 inwhich the head harness and arm holder are capable of relative movementin the direction of the length of said torso portion and are resilientlybiased toward a given position relative to said torso portion.
 7. Theinvention defined in claim 1 in which the lower holder is fixed to thelower table part and in which that part is moved generally in thedirection of its length away from the upper table part as the tableparts are tilted.
 8. An orthopedic table for treating a patient lying onthe table by the application of forces tending to elongate portions ofhis body, comprising: upper holding means for holding the patient at theupper portion of his body by at least one of his head and his arms;lower holding means disposed at a position removed horizontally from theupper holding means, for holding the patient at his lower extremities;and adjustable supporting means intermediate said upper and lowerholding means for supporting, in variable degree, the torso of a patientbeing held by said upper and said lower holding means and comprising atable divided in the mid-region of its length into an upper partdisposed to underly the back of the patient and a lower part disposed tounderly the legs of the patient; said adjustable supporting meansfurther comprising means for utilizing said upper and lower tabLeportion such that the central region of the table is lowered and suchthat the ends of the table and said holding means are elevated and suchthat the lower holding means is displaced in substantially the directionof the length of said lower table section away from the mid-region ofthe table.
 9. Said invention defined in claim 8 in which said adjustablesupporting means further includes means for increasing the separation inthe horizontal direction of the upper and lower table sections when saidsections are tilted.
 10. The invention defined in claim 8 in which saidlower holder is fixed to said lower table section and in which saidmeans for displacing said lower table lower holder comprises means fordisplacing said lower table section in the direction of its length.